NJ Department of Health (NJDOH), in conjunction with New Jersey Medical School (NJMS) and NJ Department of Human Services (NJDHS), proposes to enhance the state's current understanding of and responses to health outcomes associated with Sandy to characterize morbidity and mortality associated with Sandy, utilizing existing data from health care systems, public health surveillance, and mental health programs; and to enhance data collection, surveillance, prevention and interventions statewide, examining how ongoing activities might be modified to mitigate adverse health outcomes in future disaster events. We will characterize hospitalization trends, evaluating changes after Sandy, and examine conditions that in ideal circumstances would have been managed on an outpatient basis. We will evaluate outcomes classified from real-time ED chief complaint data in comparison with uniform billing data on all ED visits. We will use findings to improve current public health syndromic surveillance activities and estimate changes in ED visits for key conditions. Using NJ death certificates data, we will identify causes of death that increased or decreased in the first month and 1-6 and 7-12 month periods after Sandy. We will look at all causes, with particular attention to injuries, carbon monoxide poisonings, cardiovascular events, and suicide. Using NJDHS FEMA Crisis Counseling Program data, we will determine characteristics of persons who used crisis counseling services over time, including frequency of use and outcome, if known. Using NJDHS clinical services data, we will determine characteristics of persons who used clinical services over time. By adding supplemental questions to NJBRFS, a complex sample survey that is on- going in New Jersey, we will determine Sandy-associated exposures and health effects to the NJ population overall. We will characterize access to care and resources reported by individuals in vulnerable populations based on ethnographic interviews. We will summarize results and describe possible risk factors for specific health outcomes. The results in hand, we will obtain feedback from stakeholders, and translate findings for applied public health use which will provide crucial resources in the event of future disasters. Characterization of NJ Poison and Information System (NJPIES) calls, contrasted and compared to ED visits and findings from interviews, will focus on how use NJPIES hotline calls for focused public health interventions.